危重病患者经皮内镜下胃/空肠造口术并发症的防治
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摘要
目的探讨经皮内镜下胃/空肠造口术并发症的预防及治疗。方法 540例危重病患者共成功行535例次经皮内镜下胃造口术(PEG)和经皮内镜下空肠造口术(PEJ),对其临床资料进行回顾性分析,观察其并发症的发生情况并分析其影响因素。结果 535例患者PEG/PEJ术后无操作相关性死亡,小并发症发生率为8.78%(47/535),成功率为99.06%(535/540)。35例患者发生47次小并发症,分别为切口感染5例次,切口渗血10例次,导管尖端移位10例次,导管堵塞12例次,造口旁渗漏10例次。严重并发症2例,均为误吸,通过非手术治疗后治愈。结论经皮内镜下胃/空肠造口术操作简便、安全,加强围手术期的处理是控制其并发症的关键。
Objective To explore the complications of prevention and treatment in Percutaneous endoscopic gastrostomy and jejunostomy.Methods The clinic data for 535 critically ill patients who undergone percutaneous endoscopic gastrostomy and jejunostomy during January 2006 to November 2011 were retrospectively studied,and the complications and their influential factors were observed.Results No patients receiving PEG/PEJ were dead.The minor complication rate was 8.78%(47/535),and success ratio was 99.06%(535/540).Among the 35 cases with 47 times of minor complications,5 cases were incisional infection,10 cases were incision bleeding,10 cases were Catheter tip displacement,12 cases were Catheter blockage and 10 cases were Parastomal leakage.Two cases with serious complications were aspiration,and were cured by non-surgical methods.Conclusion Although the application and operation of percutaneous endoscopic gastrostomy and jejunostomy are simple and safe,but appropriate handling of peroperative period is important to controlling complications.
Objective To explore the complications of prevention and treatment in Percutaneous endoscopic gastrostomy and jejunostomy.Methods The clinic data for 535 critically ill patients who undergone percutaneous endoscopic gastrostomy and jejunostomy during January 2006 to November 2011 were retrospectively studied,and the complications and their influential factors were observed.Results No patients receiving PEG/PEJ were dead.The minor complication rate was 8.78%(47/535),and success ratio was 99.06%(535/540).Among the 35 cases with 47 times of minor complications,5 cases were incisional infection,10 cases were incision bleeding,10 cases were Catheter tip displacement,12 cases were Catheter blockage and 10 cases were Parastomal leakage.Two cases with serious complications were aspiration,and were cured by non-surgical methods.Conclusion Although the application and operation of percutaneous endoscopic gastrostomy and jejunostomy are simple and safe,but appropriate handling of peroperative period is important to controlling complications.
引文
[1]吴清,谢妮,傅念,等.经皮内镜下胃造瘘术和胃空肠造瘘术在危重患者中的临床应用[J].中国内镜杂志,2012,18(8):829-831.
[2]Zopf Y,Rabe C,Bruckmoser T,et al.Percutaneous en-doscopic jejunostomy and jejunal extension tube throughpercutaneous endoscopic gastrostomy:a retrospective a-nalysis of success,complications and outcome[J].Di-gestion,2009,79(2):92-97.
[3]Gauderer MW,Ponsky JL,Izant RJ.Gastrostomy withoutlaparotomy:a percutaneous endoscopic technique[J].Nutrition,1998,14(9):736-738.
[4]Ponsky JL,Aszodi A.Percutaneous endoscopic jejunosto-my[J].Am J Gastroenterol,1984,79(2):113-116.
[5]Blomberg J,Lagergren J,Martin J.Complications afterpercutaneous endoscopic gastrostomy in a prospectivestudy[J].Scand J Gastroenterol,2012,47(6):737-742.
[6]Kusakabe A,Sato A,Sugiura R,et al.The role of per-cutaneous endoscopic gastrostomy(PEG)in palliative care[J].Gan To Kagaku Ryoho,2011,38(Suppl 1):85-86.
[7]Fascetti LF,Gamba P,Dall OL,et al.Complications ofpercutaneous endoscopic gastrostomy in children:resultsof an Italian multicenter observational study[J].Dig Liv-er Dism,2012,44(8):655-659.
[8]Sharma VK,Howden CW.Meta-analysis of randomized,controlled trials of antibiotic prophylaxis before percutane-ous endoscopic gastrostomy[J].Am J Gastroenterol,2000,95(11):3133-3136.
[2]Zopf Y,Rabe C,Bruckmoser T,et al.Percutaneous en-doscopic jejunostomy and jejunal extension tube throughpercutaneous endoscopic gastrostomy:a retrospective a-nalysis of success,complications and outcome[J].Di-gestion,2009,79(2):92-97.
[3]Gauderer MW,Ponsky JL,Izant RJ.Gastrostomy withoutlaparotomy:a percutaneous endoscopic technique[J].Nutrition,1998,14(9):736-738.
[4]Ponsky JL,Aszodi A.Percutaneous endoscopic jejunosto-my[J].Am J Gastroenterol,1984,79(2):113-116.
[5]Blomberg J,Lagergren J,Martin J.Complications afterpercutaneous endoscopic gastrostomy in a prospectivestudy[J].Scand J Gastroenterol,2012,47(6):737-742.
[6]Kusakabe A,Sato A,Sugiura R,et al.The role of per-cutaneous endoscopic gastrostomy(PEG)in palliative care[J].Gan To Kagaku Ryoho,2011,38(Suppl 1):85-86.
[7]Fascetti LF,Gamba P,Dall OL,et al.Complications ofpercutaneous endoscopic gastrostomy in children:resultsof an Italian multicenter observational study[J].Dig Liv-er Dism,2012,44(8):655-659.
[8]Sharma VK,Howden CW.Meta-analysis of randomized,controlled trials of antibiotic prophylaxis before percutane-ous endoscopic gastrostomy[J].Am J Gastroenterol,2000,95(11):3133-3136.